HOLY CROSS COLLEGE OF NURSING, KOTTIYAM

COMMUNITY HEALTH NURSING

HEALTH TALK

ON

SIDE EFFECTS IN CHEMOTHERAPY

SUBMITTED BY: SUBMITTED TO:

MR. GIREESH S PILLAI MRS. SAHITHA C

II YEAR MSc NURSING ASSISTANT PROFESSOR

HOLY CROSS COLLEGE OF HOLY CROSS COLLEGE OF

NURSING NURSING

SUBMITTED ON: 12.11.2020

Name of student : Mr. Gireesh S Pillai Area : Palliative Ward

Subject : Community Health Nursing Type of Education : Group

Unit : Date &Time :

Topic of Lesson : Side Effect in Chemotherapy Duration : 15 Minute

Previous Knowledge of Students : From Magazines, Books, Media Venue : Palliative Ward

Method of Teaching : Lecture Cum Discussion

Resources : Flash card

 GENERAL
OBJECTIVES

At the completion of the class the group will be able to know about the side effects in chemotherapy and practice knowledge in
future with a positive attitude.

SPECIFIC OBJECTIVES:

At the end of the class group will be able to

define chemotherapy

explain the indications of chemotherapy

enumerate why does chemotherapy cause side effects

Specific Objectives
describes the side effects in chemotherapy

illustrate the management of side effects in chemotherapy

SL Time Specific Contents Teaching Student AV Aids Evaluation
No. Objectives Activities Activities

1 1 Minute INTRODUCTION Teacher Try to

A healthy body constantly replaces cells through a introduce the identify
process of dividing and growing. When cancer occurs, topic through the topic
cells reproduce in an uncontrolled manner. As a part of narration
the body produces more and more cells, they start to
occupy the space that useful cells previously took up.
Chemotherapy drugs interfere with a cancer cell’s ability
to divide and reproduce. A single drug or combination of
drugs can do this. Treatment can either:
 Attack cancer cells throughout the body or
 Target specific sites or process
Chemotherapy drugs can:
 Prevent cell division
 Target the cancer cells’ food source (the enzymes
and hormones they need to grow)
 Trigger apoptosis, or the “suicide” of cancer cells
Some emerging treatments aim to stop the growth of new
Teacher
blood vessels that supply a tumour in order to starve it.
Announces
Some scientists are concerned that this strategy might
the topic
encourage the growth and spread of cancer in some cases.
 At the end
of the class
students
will be able
to:

2 1 Minute define DEFINITION Teacher listening Flash Card

Chemo- Chemotherapy is an aggressive form of chemical drug defines & writing
therapy therapy meant to destroy rapidly growing cells in the Chemo- notes
body. It’s usually used to treat cancer, as cancer cells therapy
grow and divide faster than other cells.
(Joyce M Black)

Chemotherapy is a drug treatment that uses powerful

chemicals to kill fast-growing cells in your body.

Chemotherapy is most often used to treat cancer, since

cancer cells grow and multiply much more quickly than
most cells in the body.

What is
(American Cancer Society)
Chemo-
therapy?
3 1 Minute explain the Teacher Reading Flash card
 indications explains the AV aids
of chemo- INDICATIONS OF CHEMOTHERAPY indications of
therapy chemo-
Chemotherapy is primarily used to:
therapy
 Lower the total number of cancer cells in your
body What are the
uses of
 Reduce the likelihood of cancer spreading
chemo-
 Shrink tumour size therapy?
 Reduce current symptoms
4 1 Minute enumerate Teacher Asking Flash card
why does WHY DOES CHEMOTHERAPY CAUSE enumerates doubts
chemo- SIDE EFFECTS? why does
therapy Chemotherapy works on active cells. Active cells are chemo-
cause side cells that are growing and dividing into more of the same therapy cause
effects type of cell. Cancer cells are active, but so are some side effects
healthy cells. These include cells in your blood, mouth,
digestive system, and hair follicles. Side effects happen
when chemotherapy damages these healthy cells.
Why does
chemo-
therapy cause
side effects?
5 5 Minute describe the Teacher Reading Flash card
side effects Describe the AV aids
of chemo- side effects
therapy SIDE EFFECTS IN CHEMOTHERAPY of chemo-
therapy
As with most drugs, chemotherapy drugs do have side
effects.  Side effects of chemotherapy are unwanted
things that happen as a direct result of taking a drug.  It is
easy to confuse drug side effects with symptoms of
cancer.  Symptoms are the things that happen as a direct
result of the cancer and have nothing to do with the drug. 

Different chemotherapy drugs have different short term

and long term side effects and certainly not all
chemotherapy drugs cause every side effect.   In general,
chemotherapy damages cells that are dividing, so the
parts of the body where normal cells divide frequently are
likely to be affected by chemotherapy.  The mouth,
intestines, skin, hair, bone marrow (the spongy material
that fills your bones and produces new blood cells) are
commonly affected by chemotherapy.  Hair is growing all
the time. The skin is constantly renewing itself. So are the
lining of the mouth and digestive system.  To do this, the
cells of all these body tissues must constantly divide to Teacher Actively
produce a steady supply of new cells.  And when cells are Describe the observing Flash card
side effects
dividing, chemotherapy drugs can attack them. of chemo-
therapy
Although most anti-cancer drugs have side effects, not
everyone will get these effects.  A person may experience
no side effects of chemotherapy, some side effects, or all
of them.  Whether or not a person will experience a
particular side effect, when it will start and stop or how
bad it will be depending on many factors.  Some of these
factors are, how long a person has been taking the drug, a
person's general health, the dose or amount of the drug,
the way the drug is given, other drugs that may be given
in combination.

Some important points to remember in regards to short

and long term chemotherapy side effects are:

 Some side effects of chemotherapy are serious

medical conditions that need to be treated.
 Some side effects are inconvenient or upsetting
but are not damaging to your health.
 Discuss side effects with your health care team.
Teacher Asking
 If you are worried about a side effect call your
Describe the doubts
doctor or the contact at the center where your
side effects Flash card
treatment is being given (make sure you have a
of chemo-
 phone number of who to call). therapy
 Most side effects don't do any lasting harm and
will gradually go away after treatment finishes.
 If you do not get side effects, it does not mean
your treatment is not working.
 There are very few long term side effects of
chemotherapy.  Most are short-term.

The side effects of chemotherapy can be unpleasant. But

it can help to try to see the problems in relation to the
benefits of the treatment.  Chemotherapy does not cause
side effects in everyone.

CIRCULATORY AND IMMUNE SYSTEMS

Routine blood count monitoring is a crucial part of

chemotherapy. That’s because the drugs can harm cells in
the bone marrow, where red blood cells are produced.
Without enough red blood cells to carry oxygen to
tissues, client may experience anaemia. Teacher Observing
Describe the AV aids
Symptoms of anaemia may include: side effects
of chemo- Flash card
 Fatigue
therapy
  Light headedness

 Pale skin

 Difficulty thinking

 Feeling cold

 General weakness

Chemo can also lower white blood cell count

(neutropenia). White blood cells play an important role in
the immune system. They help prevent illnesses and fight
infections. Symptoms aren’t always obvious, but client
might find client self-getting sick more often than client
used to. Be sure to take precautions to avoid exposure to
viruses, bacteria, and other germs if patient taking chemo.

Cells called platelets help blood clot. A low platelet count

(thrombocytopenia) means are likely to bruise and bleed
easily. Symptoms include long periods of nosebleeds, Teacher Active
blood in vomit or stools, and heavier-than-normal Describe the carefully
menstruation. side effects
of chemo-
Finally, some chemo drugs can damage the heart by
therapy Flash card
weakening your heart muscle (cardiomyopathy) or disturb
your heart rhythm (arrhythmia). These conditions can
affect your heart’s ability to pump blood effectively.
Some chemo drugs may even increase your risk for heart
attack. These problems are less likely to occur if your
heart is strong and healthy when you start chemotherapy.

NERVOUS AND MUSCULAR SYSTEMS

The central nervous system controls emotions, thought

patterns, and coordination. Chemotherapy drugs may
cause problems with memory, or make it difficult to
concentrate or think clearly. This symptom sometimes is
called “chemo fog,” or “chemo brain.” This mild
cognitive impairment may go away following treatment
or may linger for years. Severe cases can even add to
existing anxiety and stress.
Teacher Listen
Some chemo drugs can also cause:
Describe the carefully
side effects
 Pain
of chemo-
 Weakness
therapy
 Numbness
Flash card
 Tingling in the hands and feet (peripheral
 neuropathy)

Client muscles may feel tired, achy, or shaky. And client

reflexes and small motor skills may slow down. Patient
may also experience problems with balance and
coordination.

DIGESTIVE SYSTEM

Some of the most common side effects of chemotherapy

affect digestion. Dry mouth and mouth sores that form on
the tongue, lips, gums, or in the throat can make it
difficult to chew and swallow. Mouth sores also make
patient more susceptible to bleeding and infection. Client
might even have a metallic taste in the mouth, or a yellow
or white coating on your tongue. Food may taste unusual
or unpleasant, leading to unintentional weight loss from
Teacher Asking
not eating.
Describe the Doubts
These powerful drugs can also harm cells along the side effects
gastrointestinal tract. Nausea is a common symptom and of chemo-
may result in vomiting. Anti-nausea medications to therapy
reduce vomiting during treatment.
Flash card
Other digestive issues include loose or hard stools and
diarrhoea or constipation. Client may also feel pressure,
bloating, and gas around the abdomen. Patient can lessen
these symptoms by avoiding dehydration by drinking
plenty of water during the day.

Side effects involving the digestive system can contribute

to loss of appetite and feeling full even though client
haven’t eaten much. As a result, weight loss, general
weakness, and a lack of energy are common. It’s
important to continue eating healthy foods.

INTEGUMENTARY SYSTEM (SKIN, HAIR, AND

NAILS)

Hair loss is perhaps the most infamous side effect of Teacher Active
chemo treatments. Many chemotherapy drugs affect hair Describe the listening
follicles and can cause hair loss (alopecia) within a few side effects
weeks of the first treatment. Hair loss can occur anywhere of chemo-
on the body, from eyebrows and eyelashes to your legs. therapy
Hair loss is temporary. New hair growth usually begins
several weeks after the final treatment.

Flash card
Minor skin irritations like dryness, itchiness, and rash are
also possible.

SEXUAL AND REPRODUCTIVE SYSTEM

Chemotherapy drugs are known to alter hormones in both

men and women. In women, hormonal changes can bring
on hot flashes, irregular periods, or sudden onset of
menopause. Patient may experience dryness of vaginal
tissues that can make intercourse uncomfortable or
painful. The chance of developing vaginal infections also
increases.

Many doctors do not advise getting pregnant during

Teacher Asking
treatment. While some women may become temporarily
or permanently infertile as a side effect, chemotherapy Describe the doubts

drugs given during pregnancy may also cause birth side effects
defects. In men, some chemo drugs can harm sperm or of chemo-
lower sperm count. Like women, men can have therapy
temporary or permanent infertility from chemo.

While symptoms like fatigue, anxiety, and hormonal

fluctuations may interfere with sex drive in both men and Flash card
women, many people on chemotherapy are still able to
have active sex lives.

EXCRETORY SYSTEM (KIDNEYS AND BLADDER)

The kidneys work to excrete the powerful chemotherapy

drugs as they move through your body. In the process,
some kidney and bladder cells can become irritated or
damaged.

Symptoms of kidney damage include:

 Decreased urination
Teacher Listening
 Swelling of the hands
Describe the
 Swollen feet and ankles side effects
 Headache of chemo-
therapy
Client may also experience bladder irritation, which
causes a feeling of burning when urinating and increased
urinary frequency.

SKELETAL SYSTEM
Flash card
 Most people lose some bone mass as they age, but with
chemo, some drugs increase this loss by causing calcium
levels to drop. Cancer-related osteoporosis tends to affect
women more than men, especially post-menopausal
women and those whose menopause was brought on
suddenly due to chemotherapy.

According to the National Institutes of Health (NIH),

women treated for breast cancer are at increased risk for
osteoporosis and bone fracture. This is due to the
combination of the drugs and a natural drop in oestrogen
Teacher Asking
levels. Osteoporosis increases the risk of bone fractures
Describe the doubts
and breaks. The most common areas of the body to suffer
side effects What are the
breaks are the spine and pelvis, hips, and wrists. You can
of chemo- side effects in
help keep your bones strong by getting enough calcium
and regular exercise. therapy chemo-
therapy?
6 4 Minute illustrate the PSYCHOLOGICAL AND EMOTIONAL TOLL illustrate the Observing
manage- management AV aids
ment of side Living with cancer and dealing with chemotherapy can of side
effects in take an emotional toll. Client may feel fearful, stressed, or effects in
chemo- anxious about your appearance and health. Depression is chemo-
a common feeling as well, as people juggle work, family, therapy Flash card
therapy
and financial responsibilities on top of cancer treatment.

Complementary therapies like massage and meditation

can be a helpful solution for relaxation and relief, if you
have trouble coping. They may be able to suggest a local
Flash card
cancer support group where you can speak with others
undergoing cancer treatment. If feelings of depression
persist, look for professional counselling.

illustrate the Listening

MANAGEMENT WITH SIDE EFFECT IN management

of side
CHEMOTHERAPY
effects in

MANAGING FATIGUE chemo-

therapy
 Plan activities for the time of day when client tend
to feel most energetic.
 Allow client body to recover by taking regular
breaks.
 Make time for regular exercise.
 Ask for, and accept, offers of support from family,
friends and neighbours. They can help with Flash card
 shopping, driving, housework or gardening.
 If client have children, ask trusted family and
friends to look after them during your
chemotherapy sessions and to be on call in case
you become unwell afterwards.
 Find ways to manage anxiety and/or trouble
sleeping as these can affect fatigue. Relaxation or
meditation exercises may help improve your sleep
or give you more energy. Call 13 11 20 and check
whether your local Cancer Council can provide illustrate the Asking
CDs, or listen to The Thing About Cancer podcast management doubts
of fatigue and sleep. of side
 Consider trying acupuncture – some studies effects in
suggest this may help reduce physical tiredness chemo-
after chemotherapy. therapy

 See below for tips on dealing with exhaustion

caused by a poor appetite, nausea and/or vomiting.
 Check with your doctor whether your fatigue is
related to low levels of red blood cells
(anaemia). Anaemia can be treated.
 Discuss the impact of the treatment with your
employer. Some workplaces may allow you to
Flash card
 work flexibly during or after chemotherapy.
Options include taking a few weeks off, reducing
hours or working from home.

MANAGING APPETITE LOSS

 Eat what you feel like, when you feel like it. Have
frequent snacks instead of large meals.
 Try to eat extra on days when you have an
appetite. illustrate the Asking
 Avoid strong odours and cooking smells that may management doubts
put you off eating. It might help to prepare meals of side
ahead and freeze them for days you don't feel like effects in
cooking. chemo-

 If the taste of certain foods has changed, don't therapy

force yourself to eat them. Your sense of taste
should return to normal after treatment ends.
 If you don't feel like eating solid foods, try
enriching your drinks with powdered milk,
yoghurt, eggs or honey.
 Don't use nutritional supplements without your
doctor's advice, as some could interfere with
treatment.
Flash card
  Ask a dietitian for advice on the best eating plan
during treatment and recovery.

MANAGING NAUSEA

 Eat a light, bland meal before your treatment (e.g.

soup with dry biscuits, crackers or toast). illustrate the Asking
 Keep sipping fluids so that you don't get management doubts
dehydrated. If you aren't able to keep fluids down, of side
contact your doctor or hospital immediately. They effects in
may be able to treat the vomiting, or you may chemo-
need to have fluids through an intravenous drip in therapy
hospital.
 Sip fluids throughout the day. Sucking on ice
cubes, ice blocks or jellies can also increase your
fluid intake. If water tastes unpleasant, flavour it
with ginger cordial or syrup.
 If your stomach is upset, try drinking fizzy drinks
such as soda water or dry ginger ale.
 If you wake up feeling sick, eat a dry biscuit or
slice of toast rather than skipping food.
Flash card
  Listen to the Thing About Cancer podcast episode
on appetite loss and nausea.

MANAGING BOWEL CHANGES

Constipation illustrate the Asking

management doubts
 Eat more high-fibre foods, such as wholegrain
of side
bread and pasta, bran, fruits and vegetables, nuts
effects in
and legumes (e.g. baked beans or lentils).
chemo-
 Drink plenty of fluids, both warm and cold, to
therapy
help loosen the bowels. Prune, apple or pear juice
can work well.
 Do some light exercise, such as walking.
 Ask your doctor about using a laxative, stool
softener and/or fibre supplement.
 Avoid enemas or suppositories as they may cause
infection.
 Let client treatment team know if you have
constipation for more than a couple of days. They
will be able to help.
Flash card
Diarrhoea

 Choose bland foods such as clear broth or boiled

rice. Avoid spicy foods, wholegrain products,
fatty or fried foods, rich sauces, and raw fruits or
vegetables with skins or seeds. illustrate the Asking

 Limit alcohol, fruit juice, soft drinks, strong tea or management doubts

coffee, and dairy products, as these stimulate the of side

bowel. effects in

 Drink water to help replace fluids lost through chemo-

therapy
diarrhoea.
 Talk to client cancer care team – they may change
the treatment or suggest other solutions, such as
using over-the-counter medicines.
 If diarrhoea is severe, let client cancer care team
know. It can cause dehydration and you may need
to go to hospital.

MANAGING HAIR LOSS

 Keep hair and scalp very clean. Use a mild

shampoo like baby shampoo. If patient want to
use lotion on your head, use sorbolene. Check Flash card
 with patient nurse before using any other hair or
skin care products.
 Comb or brush hair gently using a large comb or a
hairbrush with soft bristles.
 Explain to family and friends, especially children, illustrate the Active
that the chemotherapy may make your hair fall management listening
out. of side
 Cut hair, especially if it is long, before it falls out. effects in
Some people say this gives them a sense of chemo-
control. therapy

 Wear a light cotton turban or beanie to bed if

patient has cold at night.
 Use a cotton, polyester or satin pillowcase, as
nylon can irritate your scalp.
 Talk to hairdresser about making client hair look
as good as possible even if it is thin or patchy. If
client want to dye your hair during or for about six
months after chemotherapy, it is best to use
vegetable based, non-chemical dyes.
 If client eyelashes fall out, wear sunglasses
outside to protect patient eyes from dust and sun.
 Wear a wig, hat, turban or scarf, or go bare-
Flash card
 headed – whatever feels best to client. If client
prefer to leave client head bare, protect it against
sunburn and the cold.
 Consider choosing a wig before chemotherapy illustrate the Asking
starts. Call Cancer Council 13 11 20 for assistance management doubts
in finding a wig library or shop. of side
 Consider registering for a Look Good Feel Better effects in
workshop, where you can try on wigs and other chemo-
head wear and learn new make-up techniques. therapy
Call 1800 650 960 or visit lgfb.org.au.
 Read Cancer Council's Hair Loss fact sheet
available from local Cancer Council website, or
call 13 11 20 for more information.

MOUTH CARE

 Discuss any dental issues with your oncologist

before seeing the dentist. If you need any dental
work, tell your dentist you're having
chemotherapy.
 Use a soft toothbrush to clean client teeth twice a
day.
 Rinse mouth four times a day with 1 teaspoon of
Flash card
 bicarbonate of soda or salt in a glass of warm
water. Avoid mouthwashes containing alcohol.
 Try to prevent mouth ulcers by sucking on ice illustrate the Observing
during chemotherapy sessions. management AV aids
of side
 Sip fluids, especially water, and eat moist foods effects in
such as casseroles or soups if you have a dry chemo-
mouth. Moisten foods with gravy or sauce. therapy
 Soothe tender gums or mouth with plain yoghurt.
 Blend foods to make them easier to eat. Try
smoothies made of fruit and yoghurt.
 Avoid smoking and alcoholic drinks, as well as
very hot foods and spicy, acidic or coarse foods
(e.g. nuts or grains). These can all aggravate
mouth sores.
 Read the Mouth Health and Cancer Treatment fact
sheet, available from your local Cancer Council
website, or call 13 11 20 for information.

CARE OF SKIN AND NAILS

 Use a moisturising soap or sorbolene cream as a

soap replacement. After showering, gently pat Flash card
 client skin dry with a towel rather than rubbing it.
 Use a moisturising lotion or cream containing the illustrate the Asking
ingredient urea to help with the dryness. management doubts
 Wear loose, non-restricting clothing. Choose of side
cotton fabric instead of rough wool or synthetic effects in
fibres. chemo-
 Wash client clothing in mild detergent for people therapy
with sensitive skin.
 Stop shaving or waxing until patient skin is
healed.
 Protect client skin from the sun when UV levels
are 3 or above. Wear high-protection sunscreen
(SPF 50+), a broad-brimmed hat, protective
clothing and sunglasses, and try to stay in the
shade. This advice applies to everyone, but is
7 1 Minute especially important when having chemotherapy. Teacher

 If skin becomes red or sore in the area where the summarizes

intravenous device went in, let your doctor or the topic
nurse know immediately.
 Avoid chlorinated swimming pools as the water
can make skin changes worse.

Flash card
8 1 Minute
MANAGING COGNITIVE CHANGES

 Use a calendar to keep track of tasks,

appointments, social commitments, birthdays, etc.
 Learn something new, e.g. take up a new hobby or
do crosswords or puzzles.
 Write down anything client need to remember,
9 1 Minute e.g. to-do items, where client parked the car, when Teacher
to take medicine. concludes the
topic
 Discuss these issues with client partner, family or
workplace, and ask for their support or assistance.
 Get plenty of sleep. Deep sleep is important for
memory and concentration.
10
 Do light exercise every day to help feel more alert
and sleep better.
 Read the Understanding Changes in Thinking and
Memory fact sheet, available from your local
Cancer Council website. You can also listen
to The Thing About Cancer podcast episode on
brain fog.
SUMMARY
Now learning regarding the topic we came to know the
introduction, definition, indications, side effects and side
effects managements of chemotherapy.

RECAPITULATION

1. What is chemotherapy?
2. What are the indications of chemotherapy?
3. What are the side effects in chemotherapy?
4. What are the side effects managements in
chemotherapy?

CONCLUSION

The side effects of chemotherapy generally depend on the

type of therapy being offered. Most chemotherapy side
effects cease after treatment. Although uncommon, some
treatments may produce long-term effects.
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3. K Park; Park Text Book of Preventive and Social
Medicine ;23rd edition published by Bhanot;
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